July 2015, Special ASCO Edition
Cost-Effectiveness of T-DM1 Examined
For the treatment of advanced HER2-positive breast cancer, the use of trastuzumab emtansine (T-DM1) is not cost-effective when compared with lapatinib plus capecitabine from both a societal and a payer’s perspective, according to an analysis conducted at Western University of Health Sciences College of Pharmacy in Pomona, CA.
From a societal perspective only, T-DM1 may be cost-effective compared with capecitabine monotherapy at the willingness-to-pay threshold of $150,000 per quality-adjusted life-year (QALY), Quang A. Le, PharmD, PhD, and Yuna Bae, PharmD, also reported in a poster.
In the EMILIA trial, T-DM1 significantly increased both median progression-free survival (PFS) and overall survival (OS), relative to lapatinib plus capecitabine, in patients with HER2-positive advanced breast cancer previously treated with trastuzumab and a taxane. Using data from this trial and the EGF100151 trial of capecitabine, the investigators performed an economic analysis of T-DM1 compared with lapatinib/capecitabine (LC) and with monotherapy with capecitabine from both the US payer’s perspective and a societal perspective.
The model assumed a median PFS of 9.6 months with T-DM1, 6.4 months with LC, and 4.3 months with capecitabine; median OS of 30.9 months, 25.1 months, and 15.3 months; overall response rates of 43.6%, 30.8%, and 13.9%; and duration of response of 12.6 months, 6.5 months, and 7.1 months, respectively.
Le and Bae examined outcomes with 4 possible Markov models for advanced breast cancer, comparing the projected lifetime costs and outcomes with the 3 regimens as applied to a typical 53-year-old patient (Table). From the US payer’s perspective, at the willingness-to-pay threshold of $150,000 per QALY, the analysis found a 14.1% probability that T-DM1 was cost-effective versus LC, and a 22.9% probability it was cost-effective against capecitabine. From a society perspective, these probabilities were 29.2% and 88.4%, respectively, the researchers reported.
Leonard Saltz, MD, Chief of Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York City, was given a prominent soapbox from which to voice his concerns about the rising cost of cancer care. At the plenary session, Saltz was asked to share his perspective on the rising costs of [ Read More ]
The standard of care for previously untreated HER2-positive metastatic breast cancer remains taxane/trastuzumab/pertuzumab, according to results from the MARIANNE trial, which evaluated trastuzumab emtansine (T-DM1) in this setting. While T-DM1 was not inferior to trastuzumab/taxane (HT), it did not improve outcomes over the control arm and, therefore, does not merit [ Read More ]